A virus that is present in most people in a latent state may induce or exacerbate anemia in patients with kidney disease, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings point to a new therapeutic target for affected individuals.

Lynn Butler, PhD, Cecilia Söderberg-Naucler, MD, PhD, from Karolinska Institute, in Stockholm, Sweden, and their colleagues wondered whether infection with cytomegalovirus (CMV), a type of herpes virus carried by approximately 70% of the population, might play a role in the development of anemia in these patients.

Most people carry CMV for life without any clinical symptoms because the immune system controls the infection; however, under some circumstances the virus can become active, replicate, and cause symptoms. The kidney is a target organ for CMV, and previous reports have shown that an active CMV infection is often present in transplanted kidneys.

Butler and her colleagues first looked to see if CMV could be detected in kidney biopsies from CKD patients and then investigated if, and how, the presence of such an infection could be linked to the development of anemia.


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The team discovered that kidneys from nine of 13 CKD patients were positive for active CMV infection and that patients with higher levels of anti-CMV antibodies in their blood had lower number of red blood cells. Additional tests revealed that CMV infection inhibits the ability of cells to produce EPO and that it does this by preventing the production of a protein called hypoxia inducible factor (HIF2α).

“We have established a link between CMV infection and the development of anemia in chronic kidney disease patients. Thus, this virus could provide a target for therapeutic intervention,” said Butler.

In an accompanying editorial, Michael Seifert, MD, and Daniel Brennan, MD, from the Washington University at St. Louis, lauded the investigators for their thoroughness. “A major strength of this study is the authors’ use of clinical observations, human biospecimens, animal models, and cell culture experiments to conduct true translational research that addresses an important question for clinicians,” they wrote. “We applaud this innovative study."

The article, entitled “Human Cytomegalovirus Inhibits Erythropoietin Production,” and the editorial entitled “Cytomegalovirus and Anemia: Not Just for Transplant Anymore,” appear online at http://jasn.asnjournals.org.

Study co-authors include Mensur Dzabic, MD, PhD, Frank Bakker, Belghis Davoudi, Hannah Jeffery, PhD, Piotr Religa, MD, PhD, Krzysztof Bojakowski, MD, PhD, Koonchu-Yaiw, PhD, and Afsar Rahbar, PhD.